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Definition of Bias
Bias is a systematic error that results in an
incorrect (invalid) estimate of the measure of
association
A. Bias can create spurious association when
there really is none (bias away from the null)
B. Bias can mask an association when there
really is one (bias towards the null)
C. Bias is primarily introduced by the
investigator or study participants
Bias slide #2
Selection Bias
A. Results from procedures used to select
subjects into a study that lead to a result
different from what would have been obtained
from the entire population targeted for study
B. Most likely to occur in case-control or
retrospective cohort because exposure and
outcome have occurred at time of study
selection
Bias slide #4
Bias slide #5
Had PAP
smear
Did not
have PAP
smear
Total
Cervical
Cancer
Cases
100
Controls
150
100
250
250
150
Had PAP
smear
Did not
have PAP
smear
Total
Cervical
Cancer
Cases
100
Controls
150
150
250
250
100
950
1000
Un50
exposed
950
1000
Exposed
50
750
800
Un-exposed 50
950
1000
Observation Bias
An error that arises from systematic
differences in the way information on
exposure or disease is obtained from the
study groups
Results in participants who are
incorrectly classified as either exposed or
unexposed or as diseased or not
diseased
Bias slide #16
Observation Bias
Occurs after the subjects have entered
the study
Several types of observation bias: recall
bias, interviewer bias, loss to follow up,
and differential and non-differential
misclassification
Bias slide #17
Observation Bias
Recall bias - People with disease
remember or report exposures differently
(more or less accurately) than those
without disease.
Can result in over- or under-estimate of
measure of association.
Bias slide #18
Observation Bias
OBSERVED
STUDY DATA
Case Control
Exposed
40
20
Exposed
30
20
Unexposed
60
80
Unexposed
70
80
Total
100
100
100
100
Odds Ratio:
2.7
Odds Ratio:
1.7
Observation Bias
Interviewer bias - Systematic difference
in soliciting, recording, interpreting
information.
Can occur whenever exposure
information is sought when outcome is
known (as in case-control), or when
outcome information is sought when
exposure is known (as in cohort study).
Bias slide #21
Observation Bias
Interviewer bias
Solutions: mask interviewers to study
hypothesis and disease or exposure
status of subjects, use standardized
questionnaires or standardized methods
of outcome (or exposure) ascertainment
Observation Bias
Loss to follow up - A concern in cohort and
experimental studies if people who are lost to
follow up differ from those that remain in the
study.
Bias results if subjects lost differ from those that
remain with respect to both the outcome and
exposure.
Observation Bias
Misclassification - Subjects exposure or
disease status is erroneously classified.
Two types of misclassification: non-differential
and differential. We will cover only the more
common form: non-differential
misclassification.
Observation Bias
Non-differential misclassification
Inaccuracies with respect to disease
classification are independent of exposure.
Or, inaccuracies with respect to exposure are
independent of disease. Will bias towards the
null if the exposure is has two categories.
Non-differential misclassification makes the
groups more similar.
Bias slide #25
Observation Bias
MisclassificationExample: Study of vaginal spermicides and
congenital disorders (Jick et al., 1981).
Solutions: Use multiple measurements,
most accurate source of information